rc.graycyan

416.766.1162

Visit Us:


    5 Junction Road, Toronto, ON M6N 1B5 T 416.766.1162 F 416.766.0463 www.riversideclinic.ca








    RAPID CARDIOLOGY ASSESSMENT CLINIC REFERRAL

    FAX to: 416.766.0463

    URGENCY:

    72hr
    7 days

    24hr

    REASON FOR CONSULTATION:

    Chest Pain

    Atrial Fibrillation

    Syncope

    Dyspnea


    Please attach relevant investigations / bloodwork

    TEST REQUESTED:


    Treadmill stress test

    Exercise perfusion scan

    Persantine perfusion scan

    Echocardiogram

    ECG

    Ambulatory BP Monitor


    24hr

    48hr

    7 day

    14 day

    REFERRING PHYSICIAN: